急性冠状动脉综合征患者斑块负荷与冠状动脉重构的相关性  

The study of correlation between the plaque burden and remodeling in patients with

作　　者：沈红帅 宋达琳[1,2,3] 魏美连 康维强[2] 

机构地区：[1]大连医科大学,116044 [2]青岛市市立医院老年内科,266071 [3]青岛大学,266071

出　　处：《中华医学超声杂志（电子版）》2015年第6期446-452,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：2010-2012年青岛市发展项目(2010KZJ-7);2015-2016年青岛市医药科研指导计划(2014-WJZD028)

摘　　要：目的探讨急性冠状动脉综合征(ACS)患者斑块负荷(PB)与冠状动脉重构之间的潜在关系。方法选取2011年1月至2014年6月在青岛市市立医院行常规冠状动脉造影与血管内超声(IVUS)检查的ACS患者91例。其中正性重构[重构指数(RI)>1]60例,负性重构(RI<1)31例;PB<60%9例,60%≤PB<70%19例,70%≤PB<80%48例,PB>80%15例。采用独立样本t检验比较正性重构与负性重构ACS患者斑块横截面积(P-CSA)、管腔横截面积(L-CSA)、外弹力膜横截面积(EEM-CSA)、平均EEM-CSA、PB差异;采用单因素方差分析比较不同PB的ACS患者P-CSA、L-CSA、EEM-CSA、RI差异;采用Pearson相关分析分析PB、P-CSA、EEM-CSA、L-CSA、RI的相关性。结果正性重构与负性重构ACS患者P-CSA、L-CSA、EEM-CSA、PB的差异均无统计学意义,负性重构ACS患者平均EEM-CSA大于正性重构ACS患者,且差异有统计学意义[(13.24±1.98)mm2 vs(17.30±3.16)mm2,t=2.46,P<0.05]。不同PB的ACS患者RI的差异无统计学意义,P-CSA、EEM-CSA、L-CSA的差异均有统计学意义(F=24.56、28.97、7.14,均P<0.001),且随着PB增加,P-CSA、EEM-CSA均增加[P-CSA:(6.01±1.68)、(9.12±2.00)、(11.42±2.05)、(14.05±4.00)mm2,EEM-CSA:(11.43±1.90)、(13.64±2.93)、(15.14±2.64)、(16.64±4.08)mm2],L-CSA减少[(5.44±0.89)、(4.52±0.99)、(3.72±0.74)、(2.60±0.63)mm2]。且PB与P-CSA、EEM-CSA呈正相关(r=0.76、0.50,P均<0.001),与L-CSA呈负相关性(r=-0.74,P<0.001);RI与PB、P-CSA、L-CSA、EEM-CSA均无相关性。结论冠状动脉重构是一个非常复杂的动态过程,除PB以外,可能还存在其他因素影响重构的方向,另外RI作为血管重构的评估标准可能不甚理想。Objective To discuss the potential relationship of plaque burden（PB） and coronary remodeling in acute coronary syndrome（ACS） patients. Methods Ninety-one patients with ACS in Qingdao Municipal Hospital during January 2011 to June 2014 underwent the conventional coronary angiography and intravascular ultrasonography（IVUS）. The remodeling of 60 cases were positive（remodeling index [RI]1） and those of 31 cases were negative（RI1）. All 91 patients were included in this study, including 9 cases（PB60%）, 19 cases（60% ≤ PB70%）, 48 cases（70% ≤ PB80%） and 15 cases（PB 80%）. The difference of plaque cross-sectional area（P-CSA）, lumen cross-sectional area（L-CSA）, external elastic membrane cross-sectional area（EEM-CSA）, average EEM-CSA, PB between positive remodeling and negative remodeling were compared by independent-samples t test. ANOVA was used to compare P-CSA, L-CSA, EEM-CSA and RI among patients with different PB. The relevance of PB, P-CSA, EEM-CSA, L-CSA and RI were analyzed by Pearson correlation analysis. Results There were no significant differences in P-CSA, L-CSA, EEM-CSA and PB between patients with positive remodeling and negative remodeling. Average EEM-CSA of patients with negative remodeling were significantly greater than that of patients with positive remodeling（[13.24±1.98] mm2 vs [17.30±3.16] mm2, t=2.46, P〈0.05）. P-CSA, EEM-CSA and L-CSA had significant differences（F=24.56, 28.97 and 7.14, P〈0.001） while RI had not statistical significant difference among patients with different PB. With the increase of PB, P-CSA and EEM-CSA increased（P-CSA： [6.01±1.68], [9.12±2.00], [11.42±2.05] and [14.05±4.00] mm2, EEM-CSA： [11.43±1.90], [13.64±2.93], [15.14±2.64] and [16.64±4.08] mm2）, L-CSA reduced（[5.44±0.89], [4.52±0.99], [3.72±0.74] and [2.60±0.63] mm2）. PB was positively correlated with P-CSA and EEM CSA（r=0.76, 0.50, P〈0.001）, but was negatively correlated with L-CSA（r=-0.74, P〈0.001）. RI had no relationship w

关 键 词：急性冠状动脉综合征 超声检查 介入性 斑块负荷 

分 类 号：R541.4[医药卫生—心血管疾病]